Title 22, Insurance

A commercial self-insurance fund shall obtain the approval of the Commissioner prior to paying any dividend or refund to its members. No such dividend or refund may be approved until twelve months after the last day of the fiscal year for which the dividend or refund is payable, …

(a) The trustees may assess from time to time members of a commercial self-insurance fund liable therefor under the terms of their policies and pursuant to this section, or the Commissioner may assess the members in the event of liquidation of the fund. (b) Each member's share of…

(a) If the assets of a commercial self-insurance fund are at any time insufficient to comply with the requirements of law or to discharge its liabilities, other than any liability on account of funds contributed by the trustees or others, and to meet the required conditions of fi…

A commercial self-insurance fund shall use an agent or agents licensed under chapter 31 of this title. A commercial self-insurance fund may petition the Commissioner to have agents licensed in accordance with chapter 31 of this title, and the fund and its licensed agents shall be…

(a) No basic insurance policy or application form where written application is required and is to be a part of the policy or contract, or printed rider or endorsement form, shall be issued by a commercial self-insurance fund unless the form has been filed with and approved by the…

(a) With respect to all classes of insurance which a commercial self-insurance fund shall underwrite, the rates shall not be excessive, inadequate, or unfairly discriminatory. (b) A rate shall be held to be excessive if the expense factors associated with the rate are not justifi…

A commercial self-insurance fund shall register with and designate the Insurance Commissioner as its agent solely for the purpose of receiving service of legal documents or process.

Commercial self-insurance funds licensed under this chapter shall be subject to periodic examination by the Commissioner in the same manner and subject to the same terms and conditions applicable to insurers as set forth in chapter 5 of this title.

Commercial self-insurance funds are subject to the fees and taxes set forth in chapter 25 of this title, except that the premium tax rate shall be one percent (1%) of the gross premiums collected by such self-insurance funds.

(a) As used in this chapter, unless the context clearly requires otherwise:(a) “Authority” means the Virgin Islands Windstorm and Earthquake Insurance Authority created by this chapter;(b) “Board” means the Board of Directors of the Authority or the Interim Board of Directors, as…

There is hereby created a body corporate and politic constituting a public corporation and autonomous governmental instrumentality of the Government of the Virgin Islands, by the name of the “Virgin Islands Windstorm and Earthquake Insurance Authority”. The Authority shall be sub…

(a) The Virgin Islands Windstorm and Earthquake Insurance Authority has the following powers and duties:(a) to provide the persons having an insurable interest in eligible property with windstorm and earthquake property insurance at reasonable rates;(b) to insure government owned…

(a) (1) The Authority shall be governed by a Board of Directors consisting of seven persons: the Commissioner of Finance and the Director of the Office of Management and Budget (who shall both serve ex officio), and five other persons appointed by the Governor with the advice and…

(a) The Authority shall adopt a Plan of Operation and may amend such Plan from time to time as is necessary to assure the fair, reasonable, and equitable provision of windstorm and earthquake property insurance and the operation of the Authority. The Plan of Operation and any ame…

(a) No claim under a windstorm and earthquake property insurance policy issued by or on behalf of the Authority may exceed $400,000 increasing annually by an inflation index approved by the Board. (b) Every policy issued by or on behalf of the Authority shall have a minimum deduc…

Any applicant, current or former policyholder, or other person or entity doing business with the Authority and who is affected by any decision of the Authority may appeal to the Insurance Commissioner in the manner, and by the method, provided for appeals in chapter 7 of this tit…

(a) The Authority shall submit to the Governor and the Legislature annually, after the close of its fiscal year, a report of the business of the Authority for the preceding fiscal year and two sets of annual statements; one prepared in accordance with National Association of Insu…

(a) Pursuant to the authority vested in the Government of the Virgin Islands by section 8(b)(i) of the Revised Organic Act of the Virgin Islands, as amended, the Government of the Virgin Islands hereby grants and empowers the Authority to issue and sell bonds from time to time an…

(a) Subject to any contractual limitations binding upon the holders of any issue of bonds, or trustees therefor including, but not limited to the restriction of the exercise of any remedy to a specified proportion or percentage of such holders, any holder of bonds, or trustee the…

(a) The purpose for which the Authority is created, and the exercise of all powers and duties of the Authority, are a public purpose. The Authority is exempt from the payment of any taxes or assessments on any of the property acquired or to be acquired by it, or on its operations…

(a) The Authority shall be dissolved within six months after a finding by the Board, and ratification by the Legislature of the Virgin Islands, of one or more of the following, provided the requirements of subsection (b) of this section have been met:(1) federal legislation has b…

This chapter maybe cited as “The Virgin Islands Third Party Administrators Act”.

(a) For purposes of this chapter:(a) “Affiliate” or “affiliated” means a person who directly or indirectly through one or more intermediaries, controls or is controlled by, or is under common control with, another specified person.(b) “Business entity” means a corporation, associ…

It is unlawful for a person to act as a TPA in the Virgin Islands unless that person is licensed as a TPA under this chapter. This prohibition does not apply to a person while employed by, or when operating under contract with the TPA licensed under this chapter. Any entity doing…

If an insurer uses the services of a TPA, any premiums or charges for insurance paid to the TPA by or on behalf of the insured party, or any collateral furnished to the TPA by or on behalf of the insured party, is considered to have been received by the insurer, and the return of…

(a) A TPA shall maintain in its principal office and make available to the payor complete books and records of all transactions performed on behalf of the payor. The books and records must be maintained as part of the TPA’s official records in accordance with prudent standards of…

A TPA who advertises on behalf of its client may use only advertising that has been approved in writing by the client in advance of its use and which conforms to the requirements of chapter 49 of this title. A TPA who mentions any current or former client in its advertising must …

(a) No TPA may act as a TPA without a written agreement between the TPA and the payor. A copy of the agreement must be retained by the TPA for the duration of the agreement and for five years thereafter. The agreement must contain all provisions required by this section, except i…

(a) All insurance charges, premiums, collateral, and loss reimbursements collected by a TPA on behalf of or for a payor, the return of premiums or collateral received from a payor, and any funds held by the TPA for the payment of claims, must be held by the TPA in a fiduciary cap…

(1) The TPA is the trustee for all money that is received to pay claims and claim adjustment expenses. All claim moneys must be deposited in a special fiduciary account in a financial institution that is located in the Virgin Islands. The special fiduciary account must be designa…

(a) For each plan that requires a TPATFA, the balance at all times must be the amount deposited plus accrued interest less authorized disbursements. If the TPATFA balance is less than the amount deposited plus accrued interest less authorized disbursements, it is presumed that th…

(a) It is unlawful for a TPA to enter into an agreement or understanding with a payor in which the effect is to make the amount of the TPA’s commissions, fees, or charges contingent upon savings effected in the payment of losses covered by the payor’s obligations. This subsection…

(a) When a TPA collects funds, the reason for collection of each item must be identified to the insured party, and each item must be shown separately from any premium. Additional charges may not be made for services to the extent the services have been already paid for by the pay…

Any policies, certificates, booklets, termination notices, or other written communications delivered by the payor to the TPA for delivery to insured parties or covered individuals must be delivered by the TPA promptly after receipt of instructions from the payor to deliver them. …

(a) A TPA applying in the Virgin Islands for licensure shall do so on a form provided by the Commissioner accompanied by the certification of an authorized representative of the TPA. (b) The application must include or be accompanied by the following information and documents:(1)…

(a) Every applicant for a TPA license shall file with the application and maintain while so licensed, a fidelity bond in favor of the Government of the Virgin Islands executed by a surety company and payable to any party injured under the terms of the bond. The bond must be conti…

A person who is not required to be licensed as a TPA under this chapter and who directly or indirectly underwrites, collects charges or premiums from, or adjusts or settles claims on residents of the Virgin Islands, only in connection with life, annuity or health coverage provide…

(1) The Commissioner may issue a license to an applicant or approve an application for registration as a TPA if the Commissioner finds that the applicant meets the standards established by this chapter including, but not limited to, the following:(1) All of the materials required…

(a) Each TPA licensed under section 1533 shall file an annual report in duplicate originals for the preceding calendar year with the Commissioner on or before March 31 of each year, or within such extension of time as the Commissioner for good cause may grant. The report must be …

(a) The Commissioner or the Commissioner’s designee may examine the records of any applicant or holder of a TPA license. (b) Any TPA or applicant being examined shall provide to the Commissioner or the Commissioner’s designee convenient and free access during business hours to al…

(a) The Commissioner shall, deny, suspend or revoke the license of a TPA, or shall issue a cease and desist order if the TPA does not have a license if, after notice and opportunity for hearing, the Commissioner finds that the TPA:(1) is in an unsound financial condition;(2) is u…

(a) If the Commissioner finds that one or more grounds exist for the revocation or suspension of a license issued under this chapter, the Commissioner may, in lieu of, or in addition to such suspension or revocation, impose a fine upon the TPA. (b) The Commissioner may impose a f…

Any person aggrieved by an order of the Commissioner may appeal to the appropriate court in accordance with the appeals procedures set forth in chapter 7 of this title.

Nothing in this chapter may be construed to permit any person or entity to receive or collect charges, contributions or premiums for, or adjust or settle claims in connection with any type of life or health benefit, unless that person or entity may through the insurance laws of a…

(1) Any TPA or any individual listed on the application as required by section 1533 who is convicted of a felony, must, not later than 30 days after the entry date of the judgment:(1) report the conviction to the Commissioner, and(2) provide the Commissioner with a copy of the ju…

Pursuant to the authority vested in the Commissioner in chapter 3, of this title the Commissioner may issue regulations for the proper administration and functioning of the provisions of this chapter.